男性骨质疏松症的病因谱

Etiology of men with osteoporosis or osteopenia

目的调查男性骨质疏松症的病因谱,为疾病的早期诊断、鉴别诊断提供参考。方法纳入2005年至2020年北京协和医院内分泌科诊断的男性骨质疏松或骨量减少患者,调查临床特征、生化指标、骨密度及骨骼X线片,依据国际疾病分类第十次修订本(International Classification of Diseases,10th Revision,ICD-10)分析男性骨质疏松症的病因谱。结果412例患者中继发性骨质疏松或骨量减少占64.6%,原发性仅占35.4%。≥50岁男性患者中,常见继发骨质疏松病因为性腺功能减退(10.7%)、帕金森病(7.2%)等;50岁以下男性患者中,继发性骨质疏松病因以性腺功能低下(29.9%)、垂体前叶功能减退(19.2%)较常见。男性低骨量患者中83.8%存在维生素D不足或缺乏。男性原发性和继发性骨质疏松及骨量减少患者腰椎和股骨近端各部位骨密度未见明显差异,但继发性骨质疏松及低骨量患者血清Ⅰ型胶原交联羧基末端肽、碱性磷酸酶水平明显高于原发性骨质疏松患者。结论男性骨质疏松症中继发性所占比例明显高于女性,且病因复杂,进行全面的鉴别诊断具有重要临床意义,骨转换生化指标升高对于男性继发性骨质疏松症具有一定的提示意义。

Objective To analyze the etiology and clinical characteristics of men with osteoporosis,to provide advice on the early and differential diagnosis of this disease.Methods We performed a retrospective analysis of men diagnosed with osteoporosis/osteopenia(OP)from 2005-2020 in the Endocrinology Department of Peking Union Medical College Hospital.Clinical and biochemical characteristics,bone mineral density and bone X-ray at baseline were collected.Etiological factors were recognized based on International Classification of Diseases,10 th Revision(ICD-10).Results A total of 412 men were included in the study.Out of these,most patients(64.6%)were diagnosed as secondary OP,and only 35.4%of patients had primary OP.Among patients older than 50 years,hypogonadism(10.7%)and Parkinson's disease(7.2%)were common causes of secondary osteoporosis.Hypogonadism(29.9%)and hypopituitarism(19.2%)were more prevalent among patients less than 50 years old.Among patients with low bone mass,83.8%of patients had vitamin D insufficiency or deficiency.No significant difference was found in lumbar and proximal femoral BMD between primary and secondary osteoporotic groups.However,patients with secondary osteoporosis or osteopenia had higher level of serum alkaline phosphatase,βcross-linked C-telopeptide of type I collagen than patients with primary osteoporosis or osteopenia.Conclusions Secondary osteoporosis is more common in men than women,and the causes of male osteoporosis are diverse.Therefore,it is of clinical values to conduct a comprehensive differential diagnosis.Elevated bone turnover markers are helpful in identifying secondary osteoporosis.